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Chap. 21 Nutrition FINAL

STUDY
PLAY
Kidney Disease Interferes with
the normal capacity of nephrons to filter waste products of body metabolism
Short-term Kidney Disease requires
basic nutrition support for healing rather than dietary restriction.
The progressive degeneration of Chronic Kidney Disease requires
dialysis treatment and nutrient modification according to indivdual disease status
Current therapy for Kidney Stones depends more on
basic nutrition and health support for medical treatment than on major food and nutrient restrictions
Functions of the Kidneys
- Make urine, through which they excrete most of the waste products of metabolism
- Control the concentrations of most constituents of body fluids, especially blood.
Basic functional uint of the kidney
nephron
Major Nephron Functions
- Filtration of materials in blood
- Reabsorption of needed substances
- Secretion of hydrogen ions to maintain acid-base balance
- Excretion of waste materials
Additional Nephron Functions
- Renin secretion (for body water balance)
- Erythropoietin secretion (for red cell production)
- Vitamin D activation
Amount of nephrons _______ as you get older.
Decline
reason why kidney function declines
Glomerulus
- part of the kidney
- Cluster of branching capillaries
- Cup-shaped membrane at the head of each nephron forms the bowman's capsule
- Filters waste products from blood
- Glomerular filtration rate: Preferred method of monitoring kidney function.
Tubules
- Proximal tubule
- Loop of Henle
- Distal tubule
- Collecting tubule
Causes of Kidney Disease
- Infection and Obstruction
- Damage from other disease
* HTN, diabetes, cardiovascular disease, gomerulonephritis
- Toxins: Chemical pesticides, animal venom, nephrotoxic medications ( antibiotics, NSAIDS, contrast dyes)
- Genetic Defects: polycystic kidney disease, medullary cystic disease
- Sociodemographic factors
* old age > 60
* race (african americans, native americans, hispanics)
- Exposure to certain chemical and environmental conditions
- Low income or education
Most common cause of Kidney Disease in the U.S.
Diabetes
Clinical Factor Risks for Kidney Disease
- Poor glycemic control in diabetes
- Hypertension
- Malnutrition
- Autoimmune disease
- Systemic infections
- Urinary tract infections
- Urinary Stones
- Lower unriary tract obstruction
- Neoplasia
- Family history of chronic kidney disease
- Recovery from acute kidney failure
- Reduction in kidney mass
- Exposure to certain nephrotoxic drugs
- Low birth weight
Medical Nutrition Therapy for Kidney Disease
- Based on the nature of the disease process and individual responses
- Length of disease
- Degree of impaired renal function
- Individual clincal symptoms
Diet Therapy for Long term Kidney Disease
more specific nutrient modifications
Diet Therapy for Extensive Kidney Disease
Extensive nutrition therapy required
Symptoms of Glomerulonephritis
PROTEINURIA
HEMATURIA
-Edema
- Mild Hypertension
- Depressed appetite
- Possible oliguria, or anuria
Treatment of Uncomplicated Acute Golmerulonephritis
- antibiotics and bed rest
Treatment for Advanced Acute Glomerulonephritis
- Possible restriction of protein, sodium
- Liberal intake of carbs
- Potassium intake may be monitored
- Fluid intake may be restricted
Signs and Symptoms of Nephrotic Syndrome
MASSIVE EDEMA
Ascites
proteinurea
distended abdomen
reduced plasma protein level
body tissue wasting
HYPOALBUMINEMIA
Nutrition Therapy for Nephrotic Syndrome
- Protein intake to meet nutrition/growth needs (without excess)
- Carbohydrates given liberally
- Decrease Lipids
- Modest sodium restriction
- Potassium monitored and intake adjusted accordingly
- Water intake restricted according urine output
Acute Renal Failure
- Sudden shut down of kidneys in response to metabolic insult (infectious disease, toxic agents, drug reactions) or traumatic injury
- Medical Emergency
- Can last days to weeks
Signs and Symptoms of Acute Renal Failure
- OLIGURIA
- proteinura
- hematuria
- LOSS OF APPETITE
- nausea/vomitting
- fatigue
- edema
- itchy skin
Acute Renal Failure can progress to
Chronic Renal Failure
Treatment for Acute Renal Failure
- May nee short-term dialysis.
Nutrition Therapy for Acute Kidney (renal) Failure
- Goal is to improve or maintain nutritional status
- Parenteral nutrition therapy may be required
- Recommendations for protein intake have been debated
- Individualized therapy based on renal function (indicated by golmerular filtration rate)
Prevent break down of protein
Catabolism
Test to figure out Kidney functioning
- glomerular filtration rate
Chronic Kidney Failure
- Caused by progressive breakdown of renal tissue, which impairs all renal functions
- Develops slowly
- No cure (other than kidney transplant)
Signs and Symptoms of Chronic Kidney Failure
- Polyuria/oligura/anuria
- Electrolyte imbalances
- Nitrogen retention
- anemia
- Hypertension
- Azotemia
- Weakness
- Shortness of Breath
- Fatigue
- Thirst
- Appetite loss
- Bleeding
- Muscular twitching
Nutrition Therapy for Chronic Kidney Failure
- Reduce protein breakdown
- Avoid dehydration or excess hydration
- Correct acidosis
- Correct electrolyte imbalances
- Control fluid and electrolyte losses
- Maintain optimal nutritional status
- Maintain appetite and morale
- Control complications of hypertension, bone pain, nervous system involvement
- Slow rate of renal failure
Diet Therapy for Chronic Kidney Failure
- Provide enough protein therapy to maintain tissue integrity while avoiding excess
- Provide amino acid supplements for protein supplementaion
- Reserve proteinfor tissue synthesis by ensuring adequate carbs and fats
- Maintain adequate volume with water
- Possibly restrict sodium, phosphate, calcium
- Supplement diet with multivitamin
Amount of Carbs needed for Chronic Kidney Failure
- 35 kCal per Kg of body weight per day
End-stage Kidney Disease
- Occurs when patient's glomerular filtration rate decreases to 15 ml/min
- Irreversible damage to most nephrons
- Dialysis or transplant are only options for treatment
Hemodialysis
- Usease an artificial kidney machine to remove toxic substances from blood, restore nutrients and metabolites
- Two to three treaments a week
- Patient's blood makes sever "round trips" through machine
- Dialysis solution (dialysate) removes excess waste material
Nutrition Therapy for a Patient on Hemodialysis
- Maintain protein and energy balance
- Prevent dehydration or fluid overload
- Maintain normal serum potassium and sodium levels
- Maintain acceptable phosphate and calcium levels.
Other Dietary Concerns for a Patient on Hemodialysis
- Avoid protein energy malnutrition by careful calculation of protein allowance
- Maintain body mass index of 25 to 28 kg/m2
- Fluid Intake: 1,000 ml/day plus amount equal to urine output
- Limit sodium 2,000 mg/day
- Limit Potassium 2,000-3,000 mg/day
- Supplement of water-soluble vitamins (B complex, C)
High Biological Value of Protein
Eggs
Fish
Lean Meant
Poultry
Peritoneal Dialysis
- Performed at home
- Patient introduces dialysate solution directly into peritoneal cavity 4-5 times per day
- Surgical insertion of permananent Catheter is required
- Disposable bag containing dialysate solution is attached to catheter
- Diet is more liberal than with hemodialysis
Nutrition Therapy for a Patient on Peritoneal Dialysis
- Increase protein intake to 1.2 to 1.3 g/kg body weight
- Increase potassium with a wide variety of fruits and veggies
- Encourage liberal fluid intake of 1500 to 2000 ml/day
- Avoid sweets and fats
- Maintain lean body weight.
Osteodystrophy
- Bone disease resulting from defective bone formation
- Found in about 40% of patients with decreased kidney function and 100% of patients with kidney failure
Neuropathy
- Central and Peripheral Neurologic Disorders
- Found in up ot 65% of patients at the initiation of dialysis
Long-Term Complications of Chronic Kidney Disease
- Osteodystrophy
- Neuropathy
Kidney Stones
- Basic cause is unknown
- Factors relating to urine or urinary tract environment contribute to formation
- Present in 5% of U.S. women and 12% of U.S. men
3 major substances that for Kidney Stones
- Calcium
- Struvite
- Uric acid
Reason why kidney stones happen more in men
Porstate gland blocks
Estrogen in women helps prevent by keeping urine alkaline
Most common type of Kidney Stone
Calcium Stones
Calcium Stones
- 70-80% of kidney stones are calcium oxalate
- Almost half result from genetic predisposition
Caused by
- Excess calcium in blood (hypercalcemia) or urine (hypercalciuria)
- Excess oxalate in urine (hyperoxaluria)
- Low levels of citrate in urien (hypocitraturia)
- Infection
Food Sources of Oxalates
- Fruits: berries, concord graps, currants, figs, fruit cocktail, plumbs rhubarb, tangerines
- Veggies: Baked/green/wax beans, beat/collard greens, beets, celery, swiss chard, chives, eggplant, endive, kale, okra, green peppers, spinach, sweet potatoes, tomatoes
- Nuts
- Cocoa, draft beer, tea
- Grits, tofu, wheat germ
Struvite Stones
- Composed of magnesium ammonium phosphate
- Mainly caused by urinary tract infections rather than specific nutrient
- No diet therapy is involved
- Usually removed surgically
Cystine Stones
- Cuased by genetic metabolic defect
- Occur rarely
Xanthine Stones
- Associated with treatment for gout and family histroy of gout
occur rarely
Uric Acid Stones
usually results from impaired metabolism of purine (gout, wasting disease)
Dont eat food with purines
Food with Purines
- Anchovies
- Sardines
- Organ meats
- Legumes, mushrooms, spinach, asparagus, cauliflower
- Alcohol
- Yeast
- Poultry
Symptoms of Kidney Stones
- Sever pain, back pain, fatigue
- Other urinary symptoms
- General weakness
- Fever
Several Considerations for Treatment of Kidney Stones
- Fluid intake to prevent accumulation of materials
- Dietary control of stone constituents
- Achievement of desired pH of urine with medication
- Use of binding agents to prevent absorption of stone elements
- Drug therapy in combination with diet therapy
Diet Therapy for Kidney Stones
******* INCREASE FLUIDS
- Decrease vitamin c and calcium intake
- Lower protein and salt in the diet
- Low purine diet for uric acid stones
- Low protein diets for cystine stones
- Increase intake of high fiber foods and phytates (whole grains) they bind with the elements that form the stones so they can be excreted.
Diet Therapy for Cystine Stones
- Low-methionine diet (essentially a low-protein diet) sometimes recommended
- In children, a regular diet to support growth is recommended
- Medical drug therapy is used to control infection or produce more alkaline urine
Diet Therapy for Calcium Kidney Stones
- Normal calcium
- Lower protein and salt
Diet Therapy for Phosphate Kidney Stones
- Low phosphorus (1,000-1,200 mg)
Diet Therapy for Oxalate Kidney Stones
- Low oxalate
Diet Therapy for Struvite Kidney Stones
- Low phsophorus (1,000-1,200 mg/day)
- Associated with urinary infections
Functional Units of the Kidneys
Nephrons
- Through these the kidney maintains life-sustaining blood levels of materials required for life and health
The nephrons accomplish their tremendous task by constantly
"laundering" the blood many times each day, returning necessary elements to the blood and eliminating the remainder in concentrated urine
At its end stage, chronic kidney disease is treat by
dialysis or kidney transplantation
Dialysis patients require close monitoring for
protein, water, and electrolyte balance